#aad? ,,congress  #b;d ,session  ,9 !   
,h\se ( ,repres5tatives1 ,u4 ,s41  ,m>* 
#ba1 #bjaf  ,,am5dm5t3  ,t ! bill f !   
,s5ate 7,s4 #aib7 entitl$ ,an ,act to   
reau?orize ! ,old] ,am]icans ,act (     
#aife1 & = o!r purposes41 d pass ) !    
foll[+ ,/rike out all aft] ! enact+     
clause & ins]t3  #a4 ,%ort title ,?is   
,act may be cit$ z ! ,old] ,am]icans    
,act ,reau?orization ,act ( #bjaf4  #b4 
,def9itions ,section #ajb ( ! ,old]     
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjjb7 is am5d$--  7#a7 by /rik+        
p>agraph 7#a7 & ins]t+ ! foll[+3  7#a7  
,! t]m abuse means ! kn[+ infliction (  
physical or psy*ological h>m or ! kn[+  
deprivation ( goods or s]vices t are    
necess>y to meet ess5tial ne$s or to    
avoid physical or psy*ological h>m4  2  
7#b7 by /rik+ p>agraph 7#c7 & ins]t+ !  
foll[+3  7#c7 ,! t]m adult protective   
s]vices means su* s]vices provid$ to    
adults z ! ,secret>y may specify &      
includes s]vices su* z--  7,a7 receiv+  
reports ( adult abuse1 neglect1 or      

exploitation2  7,b7 inve/igat+ ! reports
 describ$ 9 subp>agraph 7,a72  7,c7 case
 plann+1 monitor+1 evaluation1 & o!r    
casework & s]vices2 &  7,d7 provid+1    
arrang+ =1 or facilitat+ ! provision (  
m$ical1 social s]vice1 economic1 legal1 
h\s+1 law en=cem5t1 or o!r protective1  
em]g5cy1 or support s]vices4  2  7#c7 by
 /rik+ p>agraph 7#d7 & ins]t+ ! foll[+3 
7#d7 ,! t]m ,ag+ & ,disability ,res\rce 
,c5t] means an entity1 network1 or      
consortium e/abli%$ by a ,/ate z "p ( ! 
,/ate sy/em ( long-t]m c>e1 to provide a
 coord9at$ & integrat$ sy/em = old]     
individuals & individuals ) disabilities
 7z def9$ 9 section #c ( ! ,am]icans )  
,disabilities ,act ( #aiij 7#db         
,u4,s4,c4 #abajb771 & ! c>egiv]s ( old] 
individuals & individuals )             
disabilities1 t provides--  7,a7        
compreh5sive in=mation on ! full range (
 available public & private long-t]m c>e
 programs1 options1 s]vice provid]s1 &  
res\rces )9 a community1 includ+        
in=mation on ! availability ( integrat$ 

long-t]m c>e s]vices1 & ,f$]al or ,/ate 
programs t provide long-t]m c>e s]vices 
& supports ?r\gh home & community-bas$  
s]vice programs2  7,b7 p]son-c5t]$      
c\nsel+ to assi/ individuals 9 assess+  
_! exi/+ or anticipat$ long-t]m c>e ne$s
 & goals1 & develop+ & implem5t+ a      
p]son-c5t]$ plan = long-t]m c>e t is    
consi/5t ) ! desires ( su* an individual
 & design$ to meet ! individual's       
specific ne$s1 goals1 & circum/ances2   
7,c7 access = individuals to ! full     
range ( publicly-support$ long-t]m c>e  
s]vices & supports = :i* ! individuals  
may be eligible1 includ+ home &         
community-bas$ s]vice options1 by s]v+ z
 a conv5i5t po9t ( entry = su* programs 
& supports2 &  7,d7 9 coop]ation ) area 
ag5cies on ag+1 c5t]s = indep5d5t liv+  
describ$ 9 "p ,c ( title ,,vii ( !      
,rehabilitation ,act ( #aigc 7#bi       
,u4,s4,c4 #gif;f et seq471 & o!r        
community-bas$ entities1 in=mation &    
ref]rals reg>d+ available home &        
community-bas$ s]vices = individuals :o 

are at risk = resid+ 91 or :o reside 91 
in/itutional sett+s1 s t ! individuals h
 ! *oice to rema9 9 or to return to !   
community4  2  7#d7 9 p>agraph          
7#ad77;,b71 by ins]t+ oral heal?1 aft]  
bone d5sity12  7#e7 by /rik+ p>agraph   
7#ag7 & ins]t+ ! foll[+3  7#ag7 ,! t]m  
eld] ju/ice means-- 7,a7 f a societal   
p]spective1 ef=ts to--  7i7 prev5t1     
detect1 treat1 int]v5e 91 & prosecute   
eld] abuse1 neglect1 & exploitation2 &  
7ii7 protect old] individuals ) dim9i%$ 
capacity :ile maximiz+ _! autonomy2 &   
7,b7 f an individual p]spective1 !      
recognition ( an old] individual's      
rights1 includ+ ! "r to be free ( abuse1
 neglect1 & exploitation4  2 &  7#f7 9  
p>agraph 7#ah77;,a71 by /rik+ t]m       
exploitation means & ins]t+ t]ms        
exploitation & f9ancial exploitation    
mean4  #c4 ,adm9i/ration on ,ag+  7a7   
,be/ practices ,section #bja ( ! ,old]  
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjaa7 is am5d$-- 7#a7 9 subsection     
7d77#c7--  7,a7 9 subp>agraph 7,h71 by  

/rik+ #bjb7;a77#ba7 & ins]t+            
#bjb7;a77#ah72  7,b7 9 subp>agraph 7,k71
 by /rik+ & at ! end2  7,c7 9           
subp>agraph 7,l7-- 7i7 by /rik+ ,old]   
,am]icans ,act ,am5dm5ts ( #aiib &      
ins]t+ ,old] ,am]icans ,act             
,reau?orization ,act ( #bjaf2 &  7ii7 by
 /rik+ #gab7;h77#d74 & ins]t+           
#gab7;h77#e72 &2 &  7,d7 by add+ at !   
end ! foll[+3  7,m7 collect & analyze   
be/ practices relat$ to respond+ to eld]
 abuse1 neglect1 & exploitation 9       
long-t]m c>e facilities1 & publi% a     
report ( su* be/ practices4  2 &  7#b7 9
 subsection 7e77#b71 9 ! matt] prec$+   
subp>agraph 7,a71 by ins]t+ 1 & 9       
coord9ation ) ! heads ( ,/ate adult     
protective s]vices programs & !         
,director ( ! ,(fice ( ,long-,t]m ,c>e  
,ombudsman ,programs aft] & s]vices4    
7b7 ,tra9+ ,section #bjb ( ! ,old]      
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjab7 is am5d$-- 7#a7 9 subsection     
7a7--  7,a7 9 p>agraph 7#e71 by ins]t+  
heal? & economic be=e ne$s ( old]       

individuals2  7,b7 9 p>agraph 7#g71 by  
ins]t+ heal? & economic be=e welf>e2    
7,c7 9 p>agraph 7#ad71 by ins]t+        
7includ+ ! ,heal? ,res\rces & ,s]vices  
,adm9i/ration7 aft] o!r ag5cies2  7,d7 9
 p>agraph 7#bg71 by /rik+ & at ! end2   
7,e7 9 p>agraph 7#bh71 by /rik+ ! p]iod 
& ins]t+ a semicolon2 &  7,f7 by add+ at
 ! end ! foll[+3  7#bi7 provide         
in=mation & te*nical assi/ance to       
,/ates1 area ag5cies on ag+1 & s]vice   
provid]s1 9 collaboration ) relevant    
,f$]al ag5cies1 on provid+ effici5t1    
p]son-c5t]$ transportation s]vices1     
includ+ across geographic b\nd>ies2     
7#cj7 id5tify model programs & provide  
in=mation & te*nical assi/ance to       
,/ates1 area ag5cies on ag+1 & s]vice   
provid]s 7includ+ provid]s op]at+       
multipurpose s5ior c5t]s71 to support ! 
mod]nization ( multipurpose s5ior c5t]s2
 &  7#ca7 provide te*nical assi/ance to 
& %>e be/ practices ) ,/ates1 area      
ag5cies on ag+1 & ,ag+ & ,disability    
,res\rce ,c5t]s1 on h[ to collaborate & 

coord9ate s]vices ) heal? c>e entities1 
su* z ,f$]ally-qualifi$ heal? c5t]s1 z  
def9$ 9 section #aije7l77#b77;,b7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7l77#b77;,b771 9 ord] to improve 
c>e coord9ation = individuals ) multiple
 *ronic illnesses4  2  7#b7 9 subsection
 7b7--  7,a7 9 p>agraph 7#e7-- 7i7 9    
subp>agraph 7,b71 by /rik+ & aft] !     
semicolon2  7ii7 9 subp>agraph 7,c71 by 
ins]t+ & aft] ! semicolon2 &  7iii7 by  
add+ at ! end ! foll[+3  7,d7 :5        
feasible1 develop+1 9 consultation )    
,/ates & national organizations1 a      
consum]-fri5dly tool to assi/ old]      
individuals & _! families 9 *oos+ home &
 community-bas$ s]vices1 ) a p>ticul>   
focus on ways = consum]s to assess h[   
provid]s protect ! heal?1 safety1       
welf>e1 & rights1 includ+ ! rights      
provid$ "u section #cad1 ( old]         
individuals2  2  7,b7 9 p>agraph 7#h7-- 
7i7 9 subp>agraph 7,b71 by ins]t+ to    
id5tify & articulate goals ( c>e & aft] 
individuals2  7ii7 9 subp>agraph 7,d7-- 

7,i7 by ins]t+ respond to or be=e plan2 
&  7,,ii7 by /rik+ future long-t]m c>e  
ne$s2 & & ins]t+ long-t]m c>e ne$s22    
7iii7 9 subp>agraph 7,e71 by add+ & at !
 end2 &  7iv7 by add+ at ! end ! foll[+3
  7,f7 to provide in=mation & ref]rals  
reg>d+ available home & community-bas$  
s]vices = individuals :o are at risk =  
resid+ 91 or :o reside 91 in/itutional  
sett+s1 s t ! individuals h ! *oice to  
rema9 9 or to return to ! community2  2 
&  7#c7 by add+ at ! end ! foll[+3  7g7 
,! ,assi/ant ,secret>y %all1 z          
appropriate1 ensure t programs au?oriz$ 
"u ?is ,act include appropriate tra9+ 9 
! prev5tion ( abuse1 neglect1 &         
exploitation & provision ( s]vices t    
address eld] ju/ice & ! exploitation (  
old] individuals4  4  7c7 ,au?orization 
( appropriations ,section #bje ( ! ,old]
 ,am]icans ,act ( #aife 7#db            
,u4,s4,c4#cjaf7 is am5d$ by /rik+       
subsection 7c74  7d7 ,reports ,section  
#bjg7;a7 ( ! ,old] ,am]icans ,act (     
#aife 7#db ,u4,s4,c4 #cjah7;a77 is      

am5d$-- 7#a7 9 p>agraph 7#b71 by /rik+  
#bjb7;a77#ai7 & ins]t+ #bjb7;a77#af72 & 
7#b7 9 p>agraph 7#d71 by /rik+          
#bjb7;a77#ag7 & ins]t+ #bjb7;a77#ad74   
7e7 ,au?orization ( appropriations      
,section #baf ( ! ,old] ,am]icans ,act (
 #aife 7#db ,u4,s4,c4 #cjbj;f7 is       
am5d$--  7#a7 9 subsection 7a71 by /rik+
 su* sums & all t foll[s ?r\gh ! p]iod  
at ! end1 & ins]t+ #dj1jfc1jjj = ea* ( !
 fiscal ye>s #bjag1 #bjah1 & #bjai42    
7#b7 by am5d+ subsection 7b7 to read z  
foll[s3  7b7 ,!re are au?oriz$ to be    
appropriat$-- 7#a7 to c>ry out section  
#bjb7;a77#ba7 7relat+ to ! ,national    
,eld]c>e ,locator ,s]vice71 #b1jhh1geh =
 fiscal ye> #bjag1 #b1acb1ddj = fiscal  
ye> #bjah1 & #b1agf1aba = fiscal ye>    
#bjai2  7#b7 to c>ry out section #bae1  
#a1ijd1bge = fiscal ye> #bjag1          
#a1idd1jii = fiscal ye> #bjah1 &        
#a1ihc1ibb = fiscal ye> #bjai2  7#c7 to 
c>ry out section #bjb 7relat+ to ,eld]  
,rights ,support ,activities "u ?is     
title71 #a1cab1ijd = fiscal ye> #bjag1  

#a1cdj1cfa = fiscal ye> #bjah1 &        
#a1cfg1hag = fiscal ye> #bjai2 &  7#d7  
to c>ry out section #bjb7;b7 7relat+ to 
! ,ag+ & ,disability ,res\rce ,c5t]s71  
#f1bga1cii = fiscal ye> #bjag1          
#f1djb1eea = fiscal ye> #bjah1 &        
#f1ecc1gjc = fiscal ye> #bjai4  2 &     
7#c7 by /rik+ subsection 7c74  #d4 ,/ate
 & community programs on ag+  7a7       
,au?orization ( appropriations ,section 
#cjc ( ! ,old] ,am]icans ,act ( #aife   
7#db ,u4,s4,c4 #cjbc7 is am5d$-- 7#a7 9 
subsection 7a77#a71 by /rik+ su* sums & 
all t foll[s ?r\gh ! p]iod at ! end1 &  
ins]t+ #cef1gag1bgf = fiscal ye> #bjag1 
#cfd1def1hdg = fiscal ye> #bjah1 &      
#cgb1aif1jfi = fiscal ye> #bjai42  7#b7 
9 subsection 7b7-- 7,a7 9 p>agraph 7#a71
 by /rik+ su* sums & all t foll[s ?r\gh 
! p]iod at ! end1 & ins]t+ #dei1icg1ehf 
= fiscal ye> #bjag1 #dfi1iaf1fib =      
fiscal ye> #bjah1 & #dgi1hie1cdh =      
fiscal ye> #bjai42 &  7,b7 9 p>agraph   
7#b71 by /rik+ su* sums & all t foll[s  
?r\gh ! p]iod at ! end1 & ins]t+        

#bcb1aie1idb = fiscal ye> #bjag1        
#bcg1bcc1hag = fiscal ye> #bjah1 &      
#bdb1bga1dfe = fiscal ye> #bjai42  7#c7 
9 subsection 7d71 by /rik+ su* sums &   
all t foll[s ?r\gh ! p]iod at ! end1 &  
ins]t+ #bj1cfa1ccd = fiscal ye> #bjag1  
#bj1hjc1ajg = fiscal ye> #bjah1 &       
#ba1bdd1hfj = fiscal ye> #bjai42  7#d7 9
 subsection 7e7-- 7,a7 by /rik+ 7#a7 &  
all t foll[s ?r\gh 7#b72 &  7,b7 by     
/rik+ #aff1ejj1jjj & all t foll[s ?r\gh 
! p]iod at ! end1 & ins]t+ #aed1ccf1dhb 
= fiscal ye> #bjag1 #aeg1efd1jff =      
fiscal ye> #bjah1 & #afj1gia1feh =      
fiscal ye> #bjai4  7b7 ,allotm5t        
,section #cjd ( ! ,old] ,am]icans ,act (
 #aife 7#db ,u4,s4,c4 #cjbd7 is am5d$-- 
7#a7 9 subsection 7a77#c71 by /rik+     
subp>agraph 7,d7 & ins]t+ ! foll[+3     
7,d7 7i7 ,= ea* ( fiscal ye>s #bjag     
?r\gh #bjai1 no ,/ate %all be allott$ an
 am\nt t is less ?an #ii p]c5t ( ! am\nt
 allott$ to su* ,/ate = ! previ\s fiscal
 ye>4  7ii7 ,= fiscal ye> #bjbj & ea*   
subsequ5t fiscal ye>1 no ,/ate %all be  

allott$ an am\nt t is less ?an #ajj     
p]c5t ( ! am\nt allott$ to su* ,/ate =  
fiscal ye> #bjai4  2 &  7#b7 9          
subsection 7b71 by /rik+ subp>t #a (4   
7c7 ,plann+ & s]vice areas ,section     
#cje7;b77#e77;,c77i77,,iii7 ( ! ,old]   
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjbe7;b77#e77;,c77i77,,iii77 is am5d$  
by /rik+ plann+ & s]vices areas & ins]t+
 plann+ & s]vice areas4  7d7 ,area plans
 ,section #cjf ( ! ,old] ,am]icans ,act 
( #aife 7#db ,u4,s4,c4 #cjbf7 is am5d$--
  7#a7 9 subsection 7a7-- 7,a7 9        
p>agraph 7#a71 by /rik+ e/abli%m5t1     
ma9t5ance1 or con/ruction ( multipurpose
 s5ior c5t]s1 & ins]t+ e/abli%m5t1      
ma9t5ance1 mod]nization1 or con/ruction 
( multipurpose s5ior c5t]s 7includ+ a   
plan to use ! skills & s]vices ( old]   
individuals 9 paid & unpaid "w1 includ+ 
multig5]ational & old] individual to    
old] individual "w712 &  7,b7 9 p>agraph
 7#f7-- 7i7 9 subp>agraph 7,g71 by add+ 
& at ! end2 &  7ii7 by add+ at ! end !  
foll[+3  7,h7 9 coord9ation ) ! ,/ate   

ag5cy & ) ! ,/ate ag5cy responsible =   
eld] abuse prev5tion s]vices1 increase  
public aw>5ess ( eld] abuse1 neglect1 & 
exploitation1 & remove b>ri]s to        
education1 prev5tion1 inve/igation1 &   
treatm5t ( eld] abuse1 neglect1 &       
exploitation1 z appropriate2  2 &  7#b7 
9 subsection 7b77#c7-- 7,a7 9           
subp>agraph 7,j71 by /rik+ & at ! end2  
7,b7 by r$esignat+ subp>agraph 7,k7 z   
subp>agraph 7,l72 &  7,c7 by ins]t+ aft]
 subp>agraph 7,j7 ! foll[+3  7,k7       
protection f eld] abuse1 neglect1 &     
exploitation2 &  4  7e7 ,/ate plans     
,section #cjg7;a77#b77;,a7 ( ! ,old]    
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjbg7;a77#b77;,a77 is am5d$ by /rik+   
#bjb7;a77#bi7 & ins]t+ #bjb7;a77#bf74   
7f7 ,nutrition s]vices inc5tive program 
,section #caa7;e7 ( ! ,old] ,am]icans   
,act ( #aife 7#db ,u4,s4,c4 #cjcj;a7e77 
is am5d$ by /rik+ su* sums & all t      
foll[s ?r\gh ! p]iod at ! end1 & ins]t+ 
#afd1jee1ffd = fiscal ye> #bjag1        
#afg1dhf1ejb = fiscal ye> #bjah1 &      

#agj1iag1cdi = fiscal ye> #bjai44  7g7  
,supportive s]vices ,section #cba ( !   
,old] ,am]icans ,act ( #aife 7#db       
,u4,s4,c4 #cjcj;d7 is am5d$--  7#a7 9   
subsection 7a7-- 7,a7 9 p>agraph 7#a71  
by /rik+ or ref]ral s]vices & ins]t+    
ref]ral1 *ronic condition self-c>e      
managem5t1 or falls prev5tion s]vices2  
7,b7 9 p>agraph 7#h71 by /rik+ 7includ+ 
& all t foll[s & ins]t+ ! foll[+3       
7includ+ m5tal & behavioral heal? scre5+
 & falls prev5tion s]vices scre5+7 to   
detect or prev5t 7or bo?7 illnesses &   
injuries t occur mo/ frequ5tly 9 old]   
individuals2 &  7,c7 9 p>agraph 7#ae71  
by ins]t+ be=e ! semicolon ! foll[+3 1 &
 scre5+ = eld] abuse1 neglect1 &        
exploitation2  7#b7 9 subsection        
7b77#a71 by ins]t+ or mod]nization aft] 
con/ruction2  7#c7 9 subsection 7c71 by 
ins]t+ be=e ! p]iod ! foll[+3 1 & pursue
 opportunities = ! developm5t (         
int]g5]ational %>$ site models =        
programs or projects1 consi/5t ) !      
purposes ( ?is ,act2 &  7#d7 by add+ at 

! end ! foll[+3  7e7 ,9 ?is section1 !  
t]m adult *ild ) a disability means a   
*ild :o--  7#a7 is age #ah or old]2     
7#b7 is f9ancially dep5d5t on an old]   
individual :o is a p>5t ( ! *ild2 &     
7#c7 has a disability4  4  7h7 ,home    
deliv]$ nutrition s]vices program       
,section #ccf7a7 ( ! ,old] ,am]icans    
,act ( #aife 7#db ,u4,s4,c4 #cjcj;f7#a77
 is am5d$ by /rik+ cann$ & all t foll[s 
?r\gh meals & ins]t+ cann$1 or fre%     
foods &1 z appropriate1 supplem5tal     
foods1 & any additional meals4  7i7     
,nutrition s]vices ,section #cci ( !    
,old] ,am]icans ,act ( #aife 7#db       
,u4,s4,c4 #cjcj;g-#ba7 is am5d$ 7#a7 9  
p>agraph 7#a71 by /rik+ solicit & ins]t+
 utilize2 &  7#b7 9 p>agraph 7#b7-- 7,a7
 9 subp>agraph 7,j71 by /rik+ & at !    
end2  7,b7 9 subp>agraph 7,k71 by /rik+ 
! p]iod & ins]t+ 1 &2 &  7,c7 by add+ at
 ! end ! foll[+3  7,l7 :]e feasible1    
enc\rages ! use ( locally gr[n foods 9  
meal programs & id5tifies pot5tial      
p>tn]%ips & contracts ) local produc]s &

 provid]s ( locally gr[n foods4  4  7j7 
,evid5ce-,bas$ disease prev5tion & heal?
 promotion s]vices program ,"p ,d (     
title ,,iii ( ! ,old] ,am]icans ,act (  
#aife 7#db ,u4,s4,c4 #cjcjm et seq47 is 
am5d$--  7#a7 9 ! "p head+1 by ins]t+   
,evid5ce-,bas$ be=e ,disease2 &  7#b7 9 
section #cfa7;a71 by ins]t+ evid5ce-bas$
 aft] to provide4  7k7 ,old] relative   
c>egiv]s  7#a7 ,te*nical am5dm5t ,"p ,e 
( title ,,iii ( ! ,old] ,am]icans ,act (
 #aife 7#db ,u4,s4,c4 #cjcjs et seq47 is
 am5d$ by /rik+ ! subp>t head+ = subp>t 
#a4  7#b7 ,def9itions ,section #cgb (   
su* ,act 7#db ,u4,s4,c4 #cjcjs7 is      
am5d$--  7,a7 9 subsection 7a7-- 7i7 9  
p>agraph 7#a71 by /rik+ or :o is an     
individual ) a disability2 &  7ii7 by   
/rik+ p>agraph 7#b7 & ins]t+ ! foll[+3  
7#b7 ,individual ) a disability ,! t]m  
individual ) a disability means an      
individual ) a disability1 z def9$ 9    
section #c ( ! ,am]icans ) ,disabilities
 ,act ( #aiij 7#db ,u4,s4,c4 #abajb71 :o
 is n less ?an age #ah & n m ?an age    

#ei4  7#c7 ,old] relative c>egiv] ,! t]m
 old] relative c>egiv] means a c>egiv]  
:o-- 7,a7 7i7 is age #ee or old]2 &     
7ii7 lives )1 is ! in=mal provid] (     
9-home & community c>e to1 & is ! prim>y
 c>egiv] =1 a *ild or an individual ) a 
disability2  7,b7 9 ! case ( a c>egiv] =
 a *ild--  7i7 is ! gr&p>5t1 /epgr&p>5t1
 or o!r relative 7o!r ?an ! p>5t7 by    
blood1 m>riage1 or adoption1 ( ! *ild2  
7ii7 is ! prim>y c>egiv] ( ! *ild       
because ! biological or adoptive p>5ts  
are unable or unwill+ to s]ve z ! prim>y
 c>egiv]s ( ! *ild2 &  7iii7 has a legal
 relation%ip to ! *ild1 su* z legal     
cu/ody1 adoption1 or gu>dian%ip1 or is  
rais+ ! *ild in=mally2 &  7,c7 9 ! case 
( a c>egiv] = an individual ) a         
disability1 is ! p>5t1 gr&p>5t1 or o!r  
relative by blood1 m>riage1 or adoption1
 ( ! individual ) a disability4  2 &    
7,b7 9 subsection 7b7-- 7i7 by /rik+    
subp>t & all t foll[s ?r\gh family      
c>egiv]s & ins]t+ "p1 = family c>egiv]s2
  7ii7 by /rik+ 2 & & ins]t+ a p]iod2 & 

7iii7 by /rik+ p>agraph 7#b74  7l7      
,national family c>egiv] support program
 ,section #cgc ( ! ,old] ,am]icans ,act 
( #aife 7#db ,u4,s4,c4 #cjcjs-#a7 is    
am5d$-- 7#a7 9 subsection 7a77#b71 by   
/rik+ gr&p>5ts or old] individuals :o   
are relative c>egiv]s4 & ins]t+ old]    
relative c>egiv]s42  7#b7 9 subsection  
7c7-- 7,a7 9 p>agraph 7#a71 9 ! matt]   
prec$+ subp>agraph 7,a71 by /rik+       
gr&p>5ts & old] individuals :o are      
relative c>egiv]s1 & :o & ins]t+ old]   
relative c>egiv]s1 :o2 &  7,b7 9        
p>agraph 7#b77;,b71 by /rik+ to old]    
individuals provid+ c>e to individuals )
 sev]e disabilities1 includ+ *ildr5 )   
sev]e disabilities & ins]t+ to old]     
relative c>egiv]s ( *ildr5 ) sev]e      
disabilities1 or individuals )          
disabilities :o h sev]e disabilities2   
7#c7 9 subsection 7e77#c71 by /rik+     
gr&p>5ts or old] individuals :o are     
relative c>egiv]s & ins]t+ old] relative
 c>egiv]s2  7#d7 9 subsection           
7f77#a77;,a71 by /rik+ = fiscal ye>s    

#bjjg1 #bjjh1 #bjji1 #bjaj1 & #bjaa &   
ins]t+ = a fiscal ye>2 &  7#e7 9        
subsection 7g77#b77;,c71 by /rik+       
gr&p>5ts & old] individuals :o are      
relative c>egiv]s ( a *ild :o is n m ?an
 #ah ye>s ( age & ins]t+ old] relative  
c>egiv]s4  7m7 ,con=m+ am5dm5t ,"p ,e ( 
title ,,iii is am5d$ by /rik+ ?is subp>t
 ea* place x appe>s & ins]t+ ?is "p4    
#e4 ,activities = heal?1 indep5d5ce1 &  
longevity  7a7 ,grant programs ,section 
#daa ( ! ,old] ,am]icans ,act ( #aife   
7#db ,u4,s4,c4 #cjcb7 is am5d$--  7#a7 9
 subsection 7a7-- 7,a7 9 p>agraph 7#ab71
 by /rik+ & at ! end2  7,b7 by          
r$esignat+ p>agraph 7#ac7 z p>agraph    
7#ad72 &  7,c7 by ins]t+ aft] p>agraph  
7#ab7 ! foll[+3  7#ac7 cont9u+ support =
 program integrity initiatives conc]n+ !
 ,m$ic>e program "u title ,,xviii ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 t tra9 s5ior volunte]s to
 prev5t & id5tify heal? c>e fraud &     
abuse2 &  2  7#b7 9 subsection 7b71 by  
/rik+ out & all t foll[s ?r\gh ! p]iod  

at ! end1 & ins]t+ ! foll[+3  out--     
7#a7 ag+ network support activities "u  
?is section1 #f1baf1jed = fiscal ye>    
#bjag1 #f1cdf1jdh = fiscal ye> #bjah1 & 
#f1dgf1jdc = fiscal ye> #bjai2 &  7#b7  
eld] rights support activities "u ?is   
section1 #aj1hef1hbh = fiscal ye> #bjag1
 #aa1jhc1hgc = fiscal ye> #bjah1 &      
#aa1caj1iai = fiscal ye> #bjai4  4  7b7 
,native am]ican programs ,section       
#dah7;b7 ( ! ,old] ,am]icans ,act (     
#aife 7#db ,u4,s4,c4 #cjcb;g7b77 is     
am5d$ by /rik+ a national meet+ to tra9 
& ins]t+ national tra9+s =4  7c7 ,legal 
assi/ance = old] am]icans ,section      
#dbj7;c7 ( ! ,old] ,am]icans ,act (     
#aife 7#db ,u4,s4,c4 #cjcb;i7c77 is     
am5d$ by /rik+ national4  7d7 ,repeals  
,sections #dae1 #dai1 & #dba ( ! ,old]  
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjcb;d1 #cjcb;h1 #cjcb;j7 are repeal$4 
7e7 ,con=m+ am5dm5t ,section            
#dag7;a77#a77;,a7 ( ! ,old] ,am]icans   
,act ( #aife 7#db ,u4,s4,c4             
#cjcb;f7a77#a77;,a77 is am5d$ by /rik+  

gr&p>5ts & o!r old] individuals :o are  
relative c>egiv]s & ins]t+ old] relative
 c>egiv]s 7z def9$ 9 section #cgb74  #f4
 ,am5dm5ts to ,community ,s]vice ,s5ior 
,opportunities ,act  7a7 ,old] ,am]ican 
community s]vice employm5t program      
,section #ejb ( ! ,community ,s]vice    
,s5ior ,opportunities ,act 7#db         
,u4,s4,c4 #cjef7 is am5d$-- 7#a7 9      
subsection 7b77#a7--  7,a7 9 subp>agraph
 7,c77ii71 by /rik+ #eac7;a77#b77;,d7 & 
ins]t+ #eac7;a77#b77;,e72 &  7,b7 9     
subp>agraph 7,n77i7 by /rik+ ,work=ce   
,inve/m5t ,act ( #aiih 7#bi ,u4,s4,c4   
#bhja et seq47 & ins]t+ ,work=ce        
,innovation & ,opportunity ,act 7#bi    
,u4,s4,c4 #caja et seq472  7#b7 9       
subsection 7d7-- 7,a7 by ins]t+ & !     
local work=ce developm5t bo>d aft]      
s]vice area2 &  7,b7 by /rik+ & aft]    
,/ate ag5cy & ins]t+ 1 ! local work=ce  
developm5t bo>d1 &2 &  7#c7 9 subsection
 7e77#c71 by ins]t+ 1 ) ! ,/ate work=ce 
developm5t bo>d & local work=ce         
developm5t bo>d1 aft] ag+4  7b7         

,adm9i/ration ,section #ejc ( !         
,community ,s]vice ,s5ior ,opportunities
 ,act 7#db ,u4,s4,c4 #cjef;a7 is am5d$--
 7#a7 9 subsection 7a7--  7,a7 by       
r$esignat+ p>agraphs 7#f71 7#g71 & 7#h7 
z p>agraphs 7#g71 7#h71 & 7#i71         
respectively2  7,b7 9 p>agraph 7#c71 by 
/rik+ p>agraph 7#g7 & ins]t+ p>agraph   
7#h72  7,c7 9 p>agraph 7#d71 by /rik+   
subp>agraph 7,f7 & ins]t+ ! foll[+3     
7,f7 h[ ! activities ( grantees 9 !     
,/ate "u ?is title w be coord9at$ )     
activities c>ri$ out 9 ! ,/ate "u title 
,i ( ! ,work=ce ,innovation &           
,opportunity ,act 7#bi ,u4,s4,c4 #caaa  
et seq47 & o!r relat$ programs 7ref]r$  
to 9 ?is subp>agraph z ,,wioa & relat$  
activities71 & h[ ! ,/ate w r$uce       
unnecess>y duplication betwe5 !         
activities c>ri$ out "u ?is title & !   
,,wioa & relat$ activities4  2 &  7,d7  
by ins]t+ aft] p>agraph 7#e7 ! foll[+3  
7#f7 ,comb9$ ,/ate plan ,9 lieu ( ! plan
 describ$ 9 p>agraph 7#a71 a ,/ate may  
develop & submit a comb9$ ,/ate plan 9  

accordance ) section #ajc ( ! ,work=ce  
,innovation & ,opportunity ,act 7#bi    
,u4,s4,c4 #caac74 ,= a ,/ate t obta9s   
approval ( su* a comb9$ ,/ate plan1 t   
section #ajc %all apply 9 lieu ( ?is    
subsection & a ref]5ce 9 any o!r        
provision ( ?is title 7o!r ?an ?is      
subsection7 to a ,/ate plan %all be     
consid]$ to be a ref]5ce to t comb9$    
,/ate plan4  2 &  7#b7 9 subsection     
7b77#b77;,b77i71 by /rik+ ,work=ce      
,inve/m5t ,act ( #aiih & ins]t+ ,work=ce
 ,innovation & ,opportunity ,act4  7c7  
,coord9ation ,! head+ ( section #eaa ( !
 ,community ,s]vice ,s5ior              
,opportunities ,act 7#db ,u4,s4,c4      
#cjef;i7 is am5d$ by /rik+ ,,work=ce    
,,inve/m5t ,,act ,,( #aiih & ins]t+     
,,work=ce ,,innovation ,,& ,,opportunity
 ,,act4  7d7 ,p]=mance ,section #eac ( !
 ,community ,s]vice ,s5ior              
,opportunities ,act 7#db ,u4,s4,c4      
#cjefk7 is am5d$-- 7#a7 9 subsection    
7a7--  7,a7 9 ! subsection head+1 by    
/rik+ & ,indicators2  7,b7 9 p>agraph   

7#a7--  7i7 9 ! p>agraph head+1 by /rik+
 & indicators2 &  7ii7 by /rik+ &       
additional indicators ( p]=mance ea*    
place x appe>s2  7,c7 9 p>agraph 7#b7-- 
7i7 9 subp>agraph 7,a7--  7,i7 by /rik+ 
7,a7 & all t foll[s ?r\gh ,! & ins]t+   
7,a7 ,composition ( measures4--,!2 &    
7,,ii7 by /rik+ clause 7ii72  7ii7 by   
/rik+ subp>agraph 7,b72  7iii7 9        
subp>agraph 7,c7--  7,i7 by /rik+ 7,c7 &
 ins]t+ 7,b72 &  7,,ii7 9 ! fir/ s5t5ce1
 by /rik+ 7,a77i7 & ins]t+ 7,a72 &      
7,,iii7 by /rik+ ! second s5t5ce2 &     
7iv7 by /rik+ subp>agraphs 7,d7 & 7,e7 &
 ins]t+ ! foll[+3  7,c7 ,agreem5t on    
expect$ levels ( p]=mance  7i7 ,fir/ #b 
ye>s ,ea* grantee %all rea* agreem5t ) !
 ,secret>y on levels ( p]=mance = ea*   
measure describ$ 9 subp>agraph 7,a77i71 
= ea* ( ! fir/ #b program ye>s cov]$ by 
! grant agreem5t4 ,9 rea*+ ! agreem5t1 !
 grantee & ! ,secret>y %all take into   
acc\nt ! expect$ levels propos$ by !    
grantee & ! factors describ$ 9          
subp>agraph 7,d74 ,! levels agre$ to    

%all be consid]$ to be ! expect$ levels 
( p]=mance = ! grantee = su* program    
ye>s4  7ii7 ,?ird & f\r? ye> ,ea*       
grantee %all rea* agreem5t ) !          
,secret>y1 prior to ! ?ird program ye>  
cov]$ by ! grant agreem5t1 on levels (  
p]=mance = ea* measure describ$ 9       
subp>agraph 7,a71 = ea* ( ! ?ird & f\r? 
program ye>s s cov]$4 ,9 rea*+ !        
agreem5t1 ! grantee & ! ,secret>y %all  
take into acc\nt ! expect$ levels       
propos$ by ! grantee & ! factors        
describ$ 9 subp>agraph 7,d74 ,! levels  
agre$ to %all be consid]$ to be !       
expect$ levels ( p]=mance = ! grantee = 
su* program ye>s4  7,d7 ,factors ,9     
rea*+ ! agreem5ts describ$ 9 subp>agraph
 7,b71 ea* grantee & ! ,secret>y %all-- 
7i7 take into acc\nt h[ ! levels involv$
 comp>e ) ! expect$ levels ( p]=mance   
e/abli%$ = o!r grantees2  7ii7 ensure t 
! levels involv$ are adju/$1 us+ an     
objective /ati/ical model bas$ on !     
model e/abli%$ by ! ,secret>y 9         
accordance ) section                    

#aaf7;a77#c77;,a77viii77 ( ! ,work=ce   
,inve/m5t & ,opportunity ,act 7#bi      
,u4,s4,c4 #cada7;a77#c77;,a77viii772 &  
7iii7 take into acc\nt ! ext5t to :i* ! 
levels involv$ promote cont9u\s         
improvem5t 9 p]=mance acc\ntability on !
 core measures & ensure optimal return  
on ! inve/m5t ( ,f$]al funds4  7,e7     
,adju/m5ts bas$ on economic conditions &
 individuals s]v$ dur+ ! program ye> ,! 
,secret>y %all1 9 accordance ) !        
objective /ati/ical model develop$      
pursuant to subp>agraph 7,d77ii71 adju/ 
! expect$ levels ( p]=mance = a program 
ye> = grantees1 to reflect ! actual     
economic conditions & *>act]i/ics (     
p>ticipants 9 ! correspond+ projects    
dur+ su* program ye>4  2 &  7,d7 9      
p>agraph 7#c71 by /rik+ & to report     
in=mation on ! additional indicators (  
p]=mance2  7#b7 9 subsection 7b7-- 7,a7 
9 p>agraph 7#a7--  7i7 9 ! matt] prec$+ 
subp>agraph 7,a71 by /rik+              
7a77#b77;,a77i7 & ins]t+ 7a77#b77;,a72 &
  7ii7 by /rik+ subp>agraphs 7,b7 ?r\gh 

7,e7 & ins]t+ ! foll[+3  7,b7 ! p]c5tage
 ( project p>ticipants :o are 9         
unsubsidiz$ employm5t dur+ ! second     
qu>t] aft] exit f ! project2  7,c7 !    
p]c5tage ( project p>ticipants :o are 9 
unsubsidiz$ employm5t dur+ ! f\r? qu>t] 
aft] exit f ! project2  7,d7 ! m$ian    
e>n+s ( project p>ticipants :o are 9    
unsubsidiz$ employm5t dur+ ! second     
qu>t] aft] exit f ! project2  7,e7      
indicators ( effectiv5ess 9 s]v+        
employ]s1 ho/ ag5cies1 & project        
p>ticipants2 &  7,f7 ! numb] ( eligible 
individuals s]v$1 includ+ ! numb] (     
p>ticipat+ individuals describ$ 9       
subsection 7a77#c77;,b77ii7 or 7b77#b7 (
 section #eah4  2  7,b7 by /rik+        
p>agraph 7#b72  7,c7 by r$esignat+      
p>agraph 7#c7 z p>agraph 7#b72 &  7,d7 9
 p>agraph 7#b71 z s r$esignat$1 by /rik+
 p>agraphs 7#a7 & 7#b7 & ins]t+ p>agraph
 7#a72  7#c7 9 subsection 7c7-- 7,a7 by 
/rik+ %all-- & all t foll[s ?r\gh       
annually evaluate & ins]t+ %all annually
 evaluate2  7,b7 by /rik+ 7a77#b77;,c7 &

 ins]t+ 7a77#b77;,b72  7,c7 by /rik+    
7a77#b77;,d772 & & ins]t+               
7a77#b77;,e7742 &  7,d7 by /rik+        
p>agraph 7#b72  7#d7 9 subsection 7d7-- 
7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph
 7,a7--  7,i7 by /rik+ #bjjg & ins]t+   
#bjaf2  7,,ii7 9 clause 7i7--  7aa7 by  
/rik+ 7a77#b77;,c7 & ins]t+             
7a77#b77;,b72  7bb7 by /rik+            
7a77#b77;,d7 & ins]t+ 7a77#b77;,e72 &   
7cc7 by /rik+ describ$ & all t foll[s & 
ins]t+ a p]iod2  7,,iii7 by /rik+ clause
 7ii72 &  7,,iv7 by /rik+ #bjjf & all t 
foll[s ?r\gh 7i7 met & ins]t+ #bjaf1    
met2 &  7ii7 9 subp>agraph 7,b7--  7,i7 
9 clause 7i71 by /rik+ 7,a77i72 or at ! 
end & ins]t+ 7,a712  7,,ii7 by /rik+    
clause 7ii72  7,,iii7 by /rik+ #bjjf-- &
 all t foll[s ?r\gh 7i7 fail$ & ins]t+  
#bjaf1 fail$2 &  7,,iv7 by /rik+ &      
a*ieve ! applicable p]c5tage2  7,b7 9   
p>agraph 7#b7-- 7i7 9 subp>agraph 7,a7--
  7,i7 by /rik+ 7a77#b77;,c7 & ins]t+   
7a77#b77;,b72 &  7,,ii7 by /rik+        
7a77#b77;,d7 & ins]t+ 7a77#b77;,e72 &   

7ii7 9 subp>agraph 7,b77iii7-- 7,i7 by  
/rik+ 7beg9n+ ) program ye> #bjjg72 &   
7,,ii7 by add+ at ! end ! foll[+3  7iv7 
,use ( core indicators ,= purposes (    
assess+ grantee p]=mance "u ?is         
subp>agraph be=e program ye> #bjag1 !   
,secret>y %all use ! core indicators (  
p]=mance 9 effect at ! "t ( ! aw>d & !  
mo/ rec5t correspond+ expect$ levels (  
p]=mance4  2  7,c7 9 p>agraph 7#c7-- 7i7
 9 subp>agraph 7,a7--  7,i7 by /rik+    
7a77#b77;,c7 & ins]t+ 7a77#b77;,b72 &   
7,,ii7 by /rik+ 7a77#b77;,d7 & ins]t+   
7a77#b77;,e72 &  7ii7 9 subp>agraph     
7,b77iii71 by /rik+ 7beg9n+ ) program   
ye> #bjjg72 &  7,d7 by am5d+ p>agraph   
7#d7 to read z foll[s3  7#d7 ,special   
rule = implem5tation ,! ,secret>y %all  
implem5t ! core measures ( p]=mance     
describ$ 9 ?is section n lat] ?an       
,decemb] #ca1 #bjag4  2 &  7#e7 by am5d+
 subsection 7e7 to read z foll[s3  7e7  
,impact on grant competition ,effective 
on ,janu>y #a1 #bjah1 ! ,secret>y may n 
publi% a notice ann\nc+ a grant         

competition "u ?is title1 or solicit    
proposals = grants1 until ! day on :i* !
 ,secret>y implem5ts ! core measures (  
p]=mance4  4  7e7 ,competitive          
requirem5ts ,section #ead7;c77#d7 ( !   
,community ,s]vice ,s5ior ,opportunities
 ,act 7#db ,u4,s4,c4 #cjefl7c77#d77 is  
am5d$--  7#a7 by /rik+ & address+       
additional indicators ( p]=mance2 &     
7#b7 by /rik+ & additional indicators ( 
p]=mance4  7f7 ,au?orization (          
appropriations ,section #eag ( ! ,old]  
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjefo7 is am5d$-- 7#a7 9 subsection    
7a71 by /rik+ su* sums & all t foll[s   
?r\gh ! p]iod at ! end1 & ins]t+        
#dde1ahi1dje = fiscal ye> #bjag1        
#ded1dii1did = fiscal ye> #bjah1 &      
#dfc1hji1fje = fiscal ye> #bjai42 &     
7#b7 9 subsection 7b7-- 7,a7 9 ! #a/    
s5t5ce--  7i7 by ins]t+ ,f$]al aft]     
available =2 &  7ii7 by /rik+ ,july &   
ins]t+ ,april2 &  7,b7 by ins]t+ aft] ! 
#a/ s5t5ce ! foll[+3 ,su* am\nts        
obligat$ to grantees %all be available =

 obligation & exp5diture by grantees    
dur+ ! program ye> t beg9s on ,july #a (
 ! cal5d> ye> imm$iately foll[+ ! beg9n+
 ( ! fiscal ye> 9 :i* ! am\nts are      
appropriat$ & t ends on ,june #cj ( !   
foll[+ cal5d> ye>4 4  7g7 ,def9itions   
,section #eah7;a7 ( ! ,community ,s]vice
 ,s5ior ,opportunities ,act 7#db        
,u4,s4,c4 #cjefp7a77 is am5d$--  7#a7 by
 r$esignat+ p>agraphs 7#e7 ?r\gh 7#h7 z 
p>agraphs 7#f7 ?r\gh 7#i71 respectively2
 &  7#b7 by ins]t+ aft] p>agraph 7#d7 ! 
foll[+3  7#e7 ,local work=ce developm5t 
bo>d2 ,/ate work=ce developm5t bo>d ,!  
t]ms local work=ce developm5t bo>d &    
,/ate work=ce developm5t bo>d h ! mean+s
 giv5 ! t]ms local bo>d & ,/ate bo>d1   
respectively1 9 section #c ( ! ,work=ce 
,innovation & ,opportunity ,act 7#bi    
,u4,s4,c4 #cajb74  4  #g4 ,grants =     
,native ,am]icans ,section #fdc ( !     
,old] ,am]icans ,act ( #aife 7#db       
,u4,s4,c4 #cjegn7 is am5d$--  7#a7 9    
p>agraph 7#a71 by /rik+ su* sums & all t
 foll[s ?r\gh ! semicolon1 & ins]t+     

#ca1icd1jah = fiscal ye> #bjag1         
#cb1fja1hdc = fiscal ye> #bjah1 &       
#cc1bfi1fgj = fiscal ye> #bjai22 &  7#b7
 9 p>agraph 7#b71 by /rik+ su* sums &   
all t foll[s ?r\gh ! p]iod at ! end1 &  
ins]t+ #g1gah1eff = fiscal ye> #bjag1   
#g1hgi1ihb = fiscal ye> #bjah1 &        
#h1jda1cih = fiscal ye> #bjai44  #h4    
,vuln]able eld] rights protection       
activities  7a7 ,au?orization (         
appropriations ,section #gjb ( ! ,old]  
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjeh;a7 is am5d$-- 7#a7 9 subsection   
7a71 by /rik+ su* sums & all t foll[s   
?r\gh ! p]iod at ! end1 & ins]t+        
#af1bhj1fcj = fiscal ye> #bjag1         
#af1fba1aja = fiscal ye> #bjah1 &       
#af1ifa1egc = fiscal ye> #bjai42  7#b7  
by /rik+ subsection 7b7 & ins]t+ !      
foll[+3  7b7 ,o!r programs ,!re are     
au?oriz$ to be appropriat$ to c>ry out  
*apt]s #c & #d1 #d1hia1hgf = fiscal ye> 
#bjag1 #d1iid1agh = fiscal ye> #bjah1 & 
#e1jif1dhj = fiscal ye> #bjai4  2 &     
7#c7 by /rik+ subsection 7c74  7b7      

,ombudsman def9itions ,section #gaa7f7 (
 ! ,old] ,am]icans ,act ( #aife 7#db    
,u4,s4,c4 #cjeh;f7#f77 is am5d$ by /rik+
 old]4  7c7 ,ombudsman programs ,section
 #gab ( ! ,old] ,am]icans ,act ( #aife  
7#db ,u4,s4,c4 #cjeh;g7 is am5d$-- 7#a7 
9 subsection 7a7--  7,a7 9 p>agraph     
7#b71 by add+ at ! end ! foll[+3 ,!     
,ombudsman %all be responsible = !      
managem5t1 includ+ ! fiscal managem5t1 (
 ! ,(fice42  7,b7 9 p>agraph 7#c7--  7i7
 9 subp>agraph 7,a71 by /rik+ clause 7i7
 & ins]t+ ! foll[+3  7i7 are made by1 or
 on behalf (1 resid5ts1 includ+ resid5ts
 ) limit$ or no decisionmak+ capacity & 
:o h no kn[n legal repres5tative1 & if  
su* a resid5t is unable to communicate  
cons5t = an ,ombudsman to "w on a       
compla9t directly involv+ ! resid5t1 !  
,ombudsman %all seek evid5ce to indicate
 :at outcome ! resid5t w\ld h           
communicat$ 7&1 9 ! abs5ce ( evid5ce to 
! contr>y1 %all assume t ! resid5t wi%es
 to h ! resid5t's heal?1 safety1 welf>e1
 & rights protect$7 & %all "w to        

accompli% t outcome2 &  2  7ii7 9       
subp>agraph 7,d71 by /rik+ regul> &     
timely & ins]t+ regul>1 timely1 private1
 & unimp$$2  7iii7 9 subp>agraph        
7,h77iii7--  7,i7 by ins]t+ 1 actively  
enc\rage1 & assi/ 9 aft] provide        
te*nical support =2 &  7,,ii7 by /rik+ &
 aft] ! semicolon2  7iv7 by r$esignat+  
subp>agraph 7,i7 z subp>agraph 7,j72 &  
7v7 by ins]t+ aft] subp>agraph 7,h7 !   
foll[+3  7,i7 :5 feasible1 cont9ue to   
c>ry out ! functions describ$ 9 ?is     
section on behalf ( resid5ts transition+
 f a long-t]m c>e facility to a home c>e
 sett+2 &  2  7,c7 9 p>agraph           
7#e77;,b7--  7i7 9 clause 7vi7-- 7,i7 by
 ins]t+ 1 actively enc\rage1 & assi/ 9  
aft] support2 &  7,,ii7 by /rik+ & aft] 
! semicolon2  7ii7 by r$esignat+ clause 
7vii7 z clause 7viii72 &  7iii7 by      
ins]t+ aft] clause 7vi7 ! foll[+3  7vii7
 id5tify1 inve/igate1 & resolve         
compla9ts describ$ 9 clause 7iii7 t are 
made by or on behalf ( resid5ts ) limit$
 or no decisionmak+ capacity & :o h no  

kn[n legal repres5tative1 & if su* a    
resid5t is unable to communicate cons5t 
= an ,ombudsman to "w on a compla9t     
directly involv+ ! resid5t1 ! ,ombudsman
 %all seek evid5ce to indicate :at      
outcome ! resid5t w\ld h communicat$ 7&1
 9 ! abs5ce ( evid5ce to ! contr>y1 %all
 assume t ! resid5t wi%es to h !        
resid5t's heal?1 safety1 welf>e1 &      
rights protect$7 & %all "w to accompli% 
t outcome2 &  2  7#b7 9 subsection 7b7--
 7,a7 9 p>agraph 7#a7--  7i7 9          
subp>agraph 7,a71 by /rik+ access &     
ins]t+ private & unimp$$ access2 &  7ii7
 9 subp>agraph 7,b7--  7,i7 9 clause    
7i7-- 7aa7 9 ! matt] prec$+ subclause   
7,i71 by /rik+ ! m$ical & social records
 ( a & ins]t+ all files1 records1 & o!r 
in=mation conc]n+ a2 &  7bb7 9 subclause
 7,,ii71 by /rik+ to cons5t & ins]t+ to 
communicate cons5t2 &  7,,ii7 9 clause  
7ii71 9 ! matt] be=e subclause 7,i71 by 
/rik+ ! records & ins]t+ ! files1       
records1 & in=mation2 &  7,b7 by add+ at
 ! end ! foll[+3  7#c7 ,heal? ov]sight  

ag5cy ,= purposes ( section #bfd7;c7 ( !
 ,heal? ,insurance ,portability &       
,acc\ntability ,act ( #aiif 7includ+    
regulations issu$ "u t section7 7#db    
,u4,s4,c4 #acbj;d-#b note71 ! ,ombudsman
 & a repres5tative ( ! ,(fice %all be   
consid]$ a heal? ov]sight ag5cy1 s t    
release ( resid5ts' individually        
id5tifiable heal? in=mation to !        
,ombudsman or repres5tative is n        
preclud$ 9 cases 9 :i* ! requirem5ts (  
clause 7i7 or 7ii7 ( p>agraph 7#a77;,b71
 or ! requirem5ts ( p>agraph 7#a77;,d71 
are o!rwise met4  2  7#c7 9 subsection  
7c77#b77;,d71 by /rik+ #bjb7;a77#ba7 &  
ins]t+ #bjb7;a77#ah72  7#d7 9 subsection
 7d7--  7,a7 9 p>agraph 7#a71 by /rik+  
files & ins]t+ files1 records1 & o!r    
in=mation2 &  7,b7 9 p>agraph 7#b7--    
7i7 9 subp>agraph 7,a7-- 7,i7 by /rik+  
files & records ea* place su* t]m appe>s
 & ins]t+ files1 records1 & o!r         
in=mation2 &  7,,ii7 by /rik+ & aft] !  
semicolon2  7ii7 9 subp>agraph 7,b7--   
7,i7 by /rik+ files or records & ins]t+ 

files1 records1 or o!r in=mation2 &     
7,,ii7 9 clause 7iii71 by /rik+ ! p]iod 
at ! end & ins]t+ 2 &2 &  7iii7 by add+ 
at ! end ! foll[+3  7,c7 not)/&+        
subp>agraph 7,b71 ensure t ! ,ombudsman 
may disclose in=mation z ne$$ 9 ord] to 
be/ s]ve resid5ts ) limit$ or no        
decisionmak+ capacity :o h no kn[n legal
 repres5tative & are unable to          
communicate cons5t1 9 ord] = !          
,ombudsman to c>ry out ! functions &    
duties describ$ 9 p>agraphs 7#c77;,a7 & 
7#e77;,b7 ( subsection 7a74  2 &  7#e7  
by /rik+ subsection 7f7 & ins]t+ !      
foll[+3  7f7 ,conflict ( int]e/  7#a7   
,individual conflict ( int]e/ ,! ,/ate  
ag5cy %all--  7,a7 ensure t no          
individual1 or memb] ( ! imm$iate family
 ( an individual1 involv$ 9 !           
designation ( ! ,ombudsman 7:e!r by     
appo9tm5t or o!rwise7 or ! designation (
 an entity designat$ "u subsection      
7a77#e71 is subject to a conflict (     
int]e/2  7,b7 ensure t no (fic] or      
employee ( ! ,(fice1 repres5tative ( a  

local ,ombudsman entity1 or memb] ( !   
imm$iate family ( ! (fic]1 employee1 or 
repres5tative1 is subject to a conflict 
( int]e/2 &  7,c7 ensure t !            
,ombudsman-- 7i7 does n h a direct      
involvem5t 9 ! lic5s+ or c]tification ( 
a long-t]m c>e facility or ( a provid] (
 a long-t]m c>e s]vice2  7ii7 does n h  
an own]%ip or inve/m5t int]e/ 7repres5t$
 by equity1 debt1 or o!r f9ancial       
relation%ip7 9 a long-t]m c>e facility  
or a long-t]m c>e s]vice2  7iii7 is n   
employ$ by1 or p>ticipat+ 9 ! managem5t 
(1 a long-t]m c>e facility or a relat$  
organization1 & has n be5 employ$ by su*
 a facility or organization )9 #a ye>   
be=e ! date ( ! det]m9ation involv$2    
7iv7 does n receive1 or h ! "r to       
receive1 directly or indirectly1        
remun]ation 79 ca% or 9 k9d7 "u a       
comp5sation arrangem5t ) an own] or     
op]ator ( a long-t]m c>e facility2  7v7 
does n h managem5t responsibility =1 or 
op]ate "u ! sup]vision ( an individual )
 managem5t responsibility =1 adult      

protective s]vices2 &  7vi7 does n s]ve 
z a gu>dian or 9 ano!r fiduci>y capacity
 = resid5ts ( long-t]m c>e facilities 9 
an (ficial capacity 7z oppos$ to s]v+ z 
a gu>dian or fiduci>y = a family memb]1 
9 a p]sonal capacity74  7#b7            
,organizational conflict ( int]e/  7,a7 
,9 g5]al ,! ,/ate ag5cy %all comply )   
subp>agraph 7,b77i7 9 a case 9 :i* !    
,(fice poses an organizational conflict 
( int]e/1 includ+ a situation 9 :i* !   
,(fice is plac$ 9 an organization t--   
7i7 is responsible = lic5s+1 c]tify+1 or
 survey+ long-t]m c>e s]vices 9 ! ,/ate2
  7ii7 is an association 7or an         
affiliate ( su* an association7 (       
long-t]m c>e facilities1 or ( any o!r   
resid5tial facilities = old]            
individuals2  7iii7 provides long-t]m   
c>e s]vices1 includ+ programs c>ri$ out 
"u a ,m$icaid waiv] approv$ "u section  
#aaae ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acae7 or "u subsection 7b7 or
 7c7 ( section #aiae ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acifn71  

or "u a ,m$icaid ,/ate plan am5dm5t "u  
subsection 7i71 7j71 or 7k7 ( section   
#aiae ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acifn72  7iv7 provides       
long-t]m c>e case managem5t2  7v7 sets  
rates = long-t]m c>e s]vices2  7vi7     
provides adult protective s]vices2      
7vii7 is responsible = eligibility      
det]m9ations = ! ,m$icaid program c>ri$ 
out "u title ,,xix ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif et seq472    
7viii7 conducts preadmission scre5+ =   
placem5ts 9 facilities describ$ 9 clause
 7ii72 or  7ix7 makes decisions reg>d+  
admission or dis*>ge ( individuals to or
 f su* facilities4  7,b7 ,id5tify+1     
remov+1 & rem$y+ organizational conflict
  7i7 ,9 g5]al ,! ,/ate ag5cy may n     
op]ate ! ,(fice or c>ry out ! program1  
directly1 or by contract or o!r         
arrangem5t ) any public ag5cy or        
nonpr(it private organization1 9 a case 
9 :i* !re is an organizational conflict 
( int]e/ 7)9 ! mean+ ( subp>agraph 7,a77
 unless su* conflict ( int]e/ has be5-- 

7,i7 id5tifi$ by ! ,/ate ag5cy2  7,,ii7 
disclos$ by ! ,/ate ag5cy to ! ,assi/ant
 ,secret>y 9 writ+2 &  7,,iii7 rem$i$ 9 
accordance ) ?is subp>agraph4  7ii7     
,action by ,assi/ant ,secret>y ,9 a case
 9 :i* a pot5tial or actual             
organizational conflict ( int]e/ 7)9 !  
mean+ ( subp>agraph 7,a77 involv+ !     
,(fice is disclos$ or report$ to !      
,assi/ant ,secret>y by any p]son or     
entity1 ! ,assi/ant ,secret>y %all      
require t ! ,/ate ag5cy1 9 accordance ) 
! policies & proc$ures e/abli%$ by !    
,/ate ag5cy "u subsection               
7a77#e77;,d77iii7--  7,i7 remove !      
conflict2 or  7,,ii7 submit1 & obta9 !  
approval ( ! ,assi/ant ,secret>y =1 an  
adequate rem$ial plan t indicates h[ !  
,ombudsman w be un5cumb]$ 9 fulfill+ all
 ( ! functions specifi$ 9 subsection    
7a77#c74  2 &  7#f7 9 subsection 7h7--  
7,a7 9 p>agraph 7#c77;,a77i71 by /rik+  
old]2  7,b7 9 p>agraph 7#d71 by /rik+   
all t prec$es proc$ures & ins]t+ !      
foll[+3  7#d7 /r5g!n & update  2  7,c7  

by r$esignat+ p>agraphs 7#d7 ?r\gh 7#i7 
z p>agraphs 7#e7 ?r\gh 7#aj71           
respectively2  7,d7 by ins]t+ aft]      
p>agraph 7#c7 ! foll[+3  7#d7 ensure t !
 ,ombudsman or a designee p>ticipates 9 
tra9+ provid$ by ! ,national ,ombudsman 
,res\rce ,c5t] e/abli%$ 9 section       
#bjb7;a77#ah72  2  7,e7 9 p>agraph      
7#f77;,a71 z r$esignat$ by subp>agraph  
7,c7 ( ?is p>agraph1 by /rik+ p>agraph  
7#d7 & ins]t+ p>agraph 7#e72  7,f7 9    
p>agraph 7#g77;,a71 z r$esignat$ by     
subp>agraph 7,c7 ( ?is p>agraph1 by     
/rik+ subtitle ,c ( ! & ins]t+ subtitle 
,c ( title ,i ( !2 &  7,g7 9 p>agraph   
7#aj71 z r$esignat$ by subp>agraph 7,c7 
( ?is p>agraph1 by /rik+ 7#f71 or 7#g7 &
 ins]t+ 7#g71 or 7#h74  7d7 ,ombudsman  
regulations ,section #gac ( ! ,old]     
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjeh;h7 is am5d$-- 7#a7 9 p>agraph     
7#a71 by /rik+ p>agraphs 7#a7 & 7#b7 (  
section #gab7;f7 & ins]t+ subp>agraphs  
7,a7 & 7,b7 ( section #gab7;f77#a72 &   
7#b7 9 p>agraph 7#b71 by /rik+          

subp>agraphs 7,a7 ?r\gh 7,d7 ( section  
#gab7;f77#c7 & ins]t+ clauses 7i7 ?r\gh 
7vi7 ( section #gab7;f77#a77;,c74  7e7  
,prev5tion ( eld] abuse1 neglect1 &     
exploitation ,section #gba ( ! ,old]    
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjeh;i7 is am5d$--  7#a7 9 subsection  
7b7-- 7,a7 9 ! matt] prec$+ p>agraph    
7#a71 by /rik+ 7includ+ f9ancial        
exploitation72  7,b7 by r$esignat+      
p>agraphs 7#e7 ?r\gh 7#ab7 z p>agraphs  
7#f7 ?r\gh 7#ac71 respectively2  7,c7 by
 ins]t+ aft] p>agraph 7#d7 ! foll[+3    
7#e7 promot+ ! submission ( data on eld]
 abuse1 neglect1 & exploitation = !     
appropriate database ( ! ,adm9i/ration  
or ano!r database specifi$ by !         
,assi/ant ,secret>y2  2  7,d7 9 p>agraph
 7#aj77;,c71 z r$esignat$ by subp>agraph
 7,b7 ( ?is p>agraph--  7i7 9 clause    
7ii71 by ins]t+ 1 su* z =5sic           
speciali/s1 aft] su* p]sonnel2 &  7ii7 9
 clause 7v71 by ins]t+ be=e ! comma !   
foll[+3 1 includ+ programs & arrangem5ts
 t protect aga9/ f9ancial exploitation2 

&  7,e7 9 p>agraph 7#ab71 z r$esignat$  
by subp>agraph 7,b7 ( ?is p>agraph-- 7i7
 9 subp>agraph 7,d71 by /rik+ & at !    
end2 &  7ii7 by add+ at ! end ! foll[+3 
7,f7 support+ & /udy+ innovative        
practices 9 communities to develop      
p>tn]%ips across discipl9es = !         
prev5tion1 inve/igation1 & prosecution (
 abuse1 neglect1 & exploitation2 &  2 & 
7#b7 9 subsection 7e77#b71 9 ! matt]    
prec$+ subp>agraph 7,a7-- 7,a7 by /rik+ 
subsection 7b77#i77;,b77i7 & ins]t+     
subsection 7b77#aj77;,b77i72 &  7,b7 by 
/rik+ subsection 7b77#i77;,b77ii7 &     
ins]t+ subsection 7b77#aj77;,b77ii74    
#i4 ,behavioral heal? ,! ,old] ,am]icans
 ,act ( #aife is am5d$--  7#a7 9 section
 #ajb 7#db ,u4,s4,c4 #cjjb7-- 7,a7 9    
p>agraph 7#ad77;,g71 by ins]t+ &        
behavioral aft] m5tal2  7,b7 9 p>agraph 
7#cf71 by ins]t+ & behavioral aft]      
m5tal2 &  7,c7 9 p>agraph 7#dg77;,b71 by
 ins]t+ & behavioral aft] m5tal2  7#b7 9
 section #bja7;f77#a7 7#db ,u4,s4,c4    
#cjaa7;f77#a771 by ins]t+ & behavioral  

aft] m5tal2  7#c7 9 section #bjb7;a77#e7
 7#db ,u4,s4,c4 #cjab7;a77#e771 by      
ins]t+ & behavioral aft] m5tal2  7#d7 9 
section #cjf7;a7 7#db ,u4,s4,c4         
#cjbf7;a77-- 7,a7 9 p>agraph 7#b77;,a71 
by ins]t+ & behavioral aft] m5tal2 &    
7,b7 9 p>agraph 7#f77;,f71 by /rik+     
m5tal heal? s]vices ea* place su* t]m   
appe>s & ins]t+ m5tal & behavioral heal?
 s]vices2 &  7#e7 9 section #cba7;a7    
7#db ,u4,s4,c4 #cjcj;d7--  7,a7 9       
p>agraph 7#a71 z am5d$ by section       
#d7;g71 by ins]t+ & behavioral aft]     
m5tal2  7,b7 9 p>agraph 7#ad77;,b71 by  
ins]t+ & behavioral aft] m5tal2 &  7,c7 
9 p>agraph 7#bc71 by ins]t+ & behavioral
 aft] m5tal4  #aj4 ,guidance on s]v+    
,holocau/ survivors  7a7 ,9 g5]al       
,because ! s]vices "u ! ,old] ,am]icans 
,act ( #aife 7#db ,u4,s4,c4 #cjja et    
seq47 are critical to meet+ ! urg5t ne$s
 ( ,holocau/ survivors to age 9 place ) 
dignity1 com=t1 security1 & quality (   
life1 ! ,assi/ant ,secret>y = ,ag+ %all 
issue guidance to ,/ates1 t %all be     

applicable to ,/ates1 area ag5cies on   
ag+1 & provid]s ( s]vices = old]        
individuals1 ) respect to s]v+ ,holocau/
 survivors1 includ+ guidance on promis+ 
practices = conduct+ outrea* to t       
population4 ,9 develop+ ! guidance1 !   
,assi/ant ,secret>y = ,ag+ %all consult 
) exp]ts & organizations s]v+ ,holocau/ 
survivors1 & %all take into acc\nt !    
possibility t ! ne$s ( ,holocau/        
survivors may diff] bas$ on geography4  
7b7 ,cont5ts ,! guidance %all include ! 
foll[+3 7#a7 ,h[ nutrition s]vice       
provid]s may meet ! special heal?-relat$
 or o!r diet>y ne$s ( p>ticipants 9     
programs "u ! ,old] ,am]icans ,act (    
#aife1 includ+ ne$s bas$ on religi\s1   
cultural1 or e?nic requirem5ts4  7#b7   
,h[ transportation s]vice provid]s may  
address ! urg5t transportation ne$s (   
,holocau/ survivors4  7#c7 ,h[ ,/ate    
long-t]m c>e ombudsm5 may address !     
unique ne$s ( resid5ts ( long-t]m c>e   
facilities = :om in/itutional sett+s may
 produce sights1 s\nds1 smells1         

emotions1 & r\t9es1 t c induce panic1   
anxiety1 & retraumatization z a result (
 exp]i5ces f ! ,holocau/4  7#d7 ,h[     
supportive s]vices provid]s may consid] 
! unique ne$s ( ,holocau/ survivors4    
7#e7 ,h[ o!r s]vices provid$ "u t ,act1 
z det]m9$ by ! ,assi/ant ,secret>y =    
,ag+1 may s]ve ,holocau/ survivors4  7c7
 ,date ( issuance ,! guidance describ$ 9
 subsection 7a7 %all be issu$ n lat] ?an
 #ahj days aft] ! date ( enactm5t ( ?is 
,act4  ,cl]k4